﻿<?xml version="1.0" encoding="utf-8"?>
<!--267 Individual Life, Annuity and Disability Application-->
<TransactionSpecification TransactionSetIdentifierCode="267" xmlns="http://tempuri.org/X12ParserSpecification.xsd">
  <Segment SegmentId="BGN" Usage="Required" Repeat="1" />
  <Segment SegmentId="DTP" />
  <Loop LoopId="NM1">
    <Name>Individual or Organizational Name</Name>
    <StartingSegment SegmentId="NM1" />
    <Segment SegmentId="N3" Repeat="3" />
    <Segment SegmentId="N4" Repeat="1" />
    <Segment SegmentId="REF" Repeat="9" />
    <Segment SegmentId="PER" Repeat="3" />
  </Loop>
  <Loop LoopId="N1">
    <Name>Party Identification</Name>
    <StartingSegment SegmentId="N1"/>
    <Segment SegmentId="N2"/>
    <Segment SegmentId="N3"/>
    <Segment SegmentId="N4"/>
    <Segment SegmentId="N9"/>
    <Segment SegmentId="DTM"/>
    <Loop LoopId="ACT">
      <Name>Account Identification</Name>
      <StartingSegment SegmentId="ACT" />
      <Segment SegmentId="ASI" Repeat="1" />
      <Segment SegmentId="PER" />
      <Segment SegmentId="C3" Repeat="1" />
      <Segment SegmentId="LUI" />
      <Segment SegmentId="DTP" />
      <Segment SegmentId="BLI" Repeat="1" />
      <Segment SegmentId="LIN" />
      <Segment SegmentId="N4" />
      <Segment SegmentId="AM1" />
      <Segment SegmentId="AMT" />
      <Segment SegmentId="YNQ" />
      <Segment SegmentId="REF" />
      <Loop LoopId="LQ">
        <Name>Industry Code Identification</Name>
        <StartingSegment SegmentId="LQ"/>
        <Segment SegmentId="N4"/>
        <Segment SegmentId="LUI"/>
      </Loop>
      <Loop LoopId="SI">
        <Name>Service Characteristic Identification</Name>
        <StartingSegment SegmentId="SI" />
        <Segment SegmentId="AMT" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="REF" />
        <Segment SegmentId="NM1" Repeat="1" />
        <Segment SegmentId="N4" Repeat="1" />
        <Segment SegmentId="MSG" />
      </Loop>
      <Loop LoopId="PID">
        <Name>Product/Item Description</Name>
        <StartingSegment SegmentId="PID" />
        <Segment SegmentId="BLI" Repeat="1" />
        <Segment SegmentId="SPA" Repeat="1" />
        <Segment SegmentId="UD" Repeat="1" />
        <Segment SegmentId="AMT" />
        <Segment SegmentId="AM1" />
        <Segment SegmentId="PDL" />
        <Segment SegmentId="QTY" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="MSG" />
        <Loop LoopId="INV">
          <Name>Investment Vehicle Selection</Name>
          <StartingSegment SegmentId="INV" />
          <Segment SegmentId="AM1" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="LIN" Repeat="2" />
          <Segment SegmentId="RPA" />
        </Loop>
        <Loop LoopId="BEN">
          <Name>Beneficiary or Owner Information</Name>
          <StartingSegment SegmentId="BEN" />
          <Segment SegmentId="NM1" Repeat="1" />
          <Segment SegmentId="N2" Repeat="3" />
          <Segment SegmentId="N3" Repeat="3" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="REF" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="III" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="LUI" Repeat="1" />
          <Segment SegmentId="MSG" />
        </Loop>
      </Loop>
      <Loop LoopId="ENT">
        <Name>Entity</Name>
        <StartingSegment SegmentId="ENT" />
        <Segment SegmentId="NX1" />
        <Segment SegmentId="REF" />
        <Segment SegmentId="LIN" Repeat="9" />
        <Segment SegmentId="DMG" Repeat="1" />
        <Segment SegmentId="DMA" Repeat="1" />
        <Segment SegmentId="IND"/>
        <Segment SegmentId="LUI" Repeat="1" />
        <Segment SegmentId="ERI"/>
        <Segment SegmentId="DTP" />
        <Segment SegmentId="AM1" />
        <Segment SegmentId="RPA" />
        <Segment SegmentId="YNQ" />
        <Segment SegmentId="QTY" />
        <Segment SegmentId="MSG" />
        <Loop LoopId="NM1">
          <Name>Individual or Organizational Name</Name>
          <StartingSegment SegmentId="NM1" />
          <Segment SegmentId="N2" Repeat="3" />
          <Segment SegmentId="REF" />
          <Segment SegmentId="AM1" />
          <Loop LoopId="N3">
            <Name>Address Information</Name>
            <StartingSegment SegmentId="N3" />
            <Segment SegmentId="N4" Repeat="1" />
            <Segment SegmentId="COM" Repeat="9" />
            <Segment SegmentId="DTP" />
            <Segment SegmentId="QTY" />
          </Loop>
        </Loop>
        <Loop LoopId="LQ">
          <Name>Industry Code</Name>
          <StartingSegment SegmentId="LQ" />
          <Segment SegmentId="SPA" Repeat="1" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="MSG" />
          <Loop LoopId="NM1">
            <Name>Individual or Organizational Name</Name>
            <StartingSegment SegmentId="NM1" />
            <Segment SegmentId="N3" Repeat="3" />
            <Segment SegmentId="N4" Repeat="1" />
            <Segment SegmentId="REF" />
            <Segment SegmentId="COM" Repeat="3" />
            <Segment SegmentId="LUI" Repeat="1" />
            <Segment SegmentId="DTP" />
            <Segment SegmentId="MSG" />
          </Loop>
        </Loop>
        <Loop LoopId="BEN">
          <Name>Beneficiary or Owner Information</Name>
          <StartingSegment SegmentId="BEN" />
          <Segment SegmentId="NM1" Repeat="1" />
          <Segment SegmentId="N2" Repeat="3" />
          <Segment SegmentId="N3" Repeat="3" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="REF" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="III" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="AMT" />
          <Segment SegmentId="LUI" Repeat="1" />
          <Segment SegmentId="MSG" />
        </Loop>
        <Loop LoopId="PID">
          <Name>Product/Item Description</Name>
          <StartingSegment SegmentId="PID" />
          <Segment SegmentId="BLI" Repeat="9" />
          <Segment SegmentId="SPA" Repeat="1" />
          <Segment SegmentId="AMT" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="YNQ" />
          <Segment SegmentId="MSG" />
          <Loop LoopId="PDL">
            <Name>Payment Details</Name>
            <StartingSegment SegmentId="PDL" />
            <Segment SegmentId="REF" />
          </Loop>
          <Loop LoopId="INV">
            <Name>Investment Vehicle Selection</Name>
            <StartingSegment SegmentId="INV" />
            <Segment SegmentId="AM1" />
            <Segment SegmentId="DTP" />
            <Segment SegmentId="RPA" />
          </Loop>
          <Loop LoopId="BEN">
            <Name>Beneficiary or Owner Information</Name>
            <StartingSegment SegmentId="BEN" />
            <Segment SegmentId="NM1" Repeat="1" />
            <Segment SegmentId="N2" Repeat="3" />
            <Segment SegmentId="N3" Repeat="3" />
            <Segment SegmentId="N4" Repeat="1" />
            <Segment SegmentId="REF" />
            <Segment SegmentId="DTP" />
            <Segment SegmentId="III" />
            <Segment SegmentId="QTY" />
            <Segment SegmentId="AMT" />
            <Segment SegmentId="LUI" Repeat="1" />
            <Segment SegmentId="MSG" />
          </Loop>
        </Loop>
        <Loop LoopId="UC">
          <Name>Underwriting Category</Name>
          <StartingSegment SegmentId="UC" />
          <HierarchicalLoop LoopId="HL">
            <Name>Hierarchical Level</Name>
            <Segment SegmentId="UQS" Repeat="1" />
            <Segment SegmentId="YNQ" />
            <Segment SegmentId="NM1" Repeat="1" />
            <Segment SegmentId="N3" Repeat="3" />
            <Segment SegmentId="N4" Repeat="1" />
            <Segment SegmentId="COM" Repeat="9" />
            <Segment SegmentId="DTP" />
            <Segment SegmentId="QTY" />
            <Segment SegmentId="MSG" />
            <Segment SegmentId="AM1" />
            <Segment SegmentId="AMT" />
            <Segment SegmentId="III" />
            <Segment SegmentId="EC" Repeat="1" />
            <Segment SegmentId="EMS" Repeat="1" />
            <Segment SegmentId="EMP" Repeat="1" />
            <Segment SegmentId="PCT" />
            <Segment SegmentId="SOI" />
            <Segment SegmentId="LIN" Repeat="2" />
            <Segment SegmentId="REF" />
            <Segment SegmentId="ASL" />
            <Segment SegmentId="TOA" />
            <Segment SegmentId="TOV" />
            <Segment SegmentId="VEH" />
            <Segment SegmentId="CDS" />
            <Segment SegmentId="CED" />
            <Segment SegmentId="SIN" />
            <Segment SegmentId="UCS" />
            <Segment SegmentId="FH" />
            <Segment SegmentId="SPA" Repeat="1" />
            <Segment SegmentId="MPI" Repeat="1" />
          </HierarchicalLoop>
        </Loop>
      </Loop>
      <Loop LoopId="PWK">
        <Name>Paperwork</Name>
        <StartingSegment SegmentId="PWK" />
        <Segment SegmentId="NM1" Repeat="1" />
        <Segment SegmentId="N4" Repeat="1" />
        <Segment SegmentId="REF" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="SPA" Repeat="1" />
        <Loop LoopId="EFI">
          <Name>Electronic Format Identification</Name>
          <StartingSegment SegmentId="EFI" />
          <Segment SegmentId="BIN" Usage="Required" Repeat="1" />
        </Loop>
      </Loop>
      <Loop LoopId="LX">
        <Name>Assigned Number</Name>
        <StartingSegment SegmentId="LX" />
        <Loop LoopId="PDL">
          <Name>Payment Details</Name>
          <StartingSegment SegmentId="PDL" />
          <Segment SegmentId="REF" />
          <Loop LoopId="LS">
            <Name>Loop</Name>
            <StartingSegment SegmentId="LS"/>
            <Segment SegmentId="LE" Trailer="true"/>
            <Loop LoopId="AMT">
              <Name>Monetary Amount</Name>
              <StartingSegment SegmentId="AMT" />
              <Segment SegmentId="N1" Repeat="1" />
              <Segment SegmentId="N3" Repeat="2" />
              <Segment SegmentId="N4" Repeat="1" />
              <Segment SegmentId="LIN" Repeat="2" />
              <Segment SegmentId="DTP" />
              <Segment SegmentId="QTY" />
              <Segment SegmentId="MSG" />
              <Loop LoopId="AM1">
                <Name>Information Values</Name>
                <StartingSegment SegmentId="AM1"/>
                <Loop LoopId="INV">
                  <Name>Investment Vehicle Selection</Name>
                  <StartingSegment SegmentId="INV"/>
                  <Segment SegmentId="QTY"/>
                  <Segment SegmentId="DTP"/>
                  <Segment SegmentId="RPA"/>
                </Loop>
              </Loop>
            </Loop>
          </Loop>
        </Loop>
      </Loop>
      <Loop LoopId="K2">
        <Name>Administrative Message</Name>
        <StartingSegment SegmentId="K2" />
        <Segment SegmentId="DTP" Repeat="1" />
        <Segment SegmentId="NM1" Repeat="1" />
      </Loop>
    </Loop>
  </Loop>
  <Loop LoopId="ACT">
    <Name>Account Identification</Name>
    <StartingSegment SegmentId="ACT" />
    <Segment SegmentId="ASI" Repeat="1" />
    <Segment SegmentId="PER" />
    <Segment SegmentId="C3" Repeat="1" />
    <Segment SegmentId="LUI" />
    <Segment SegmentId="DTP" />
    <Segment SegmentId="BLI" Repeat="1" />
    <Segment SegmentId="LIN" />
    <Segment SegmentId="N4" />
    <Segment SegmentId="AM1" />
    <Segment SegmentId="AMT" />
    <Segment SegmentId="YNQ" />
    <Segment SegmentId="REF" />
    <Loop LoopId="SI">
      <Name>Service Characteristic Identification</Name>
      <StartingSegment SegmentId="SI" />
      <Segment SegmentId="AMT" />
      <Segment SegmentId="DTP" />
      <Segment SegmentId="REF" />
      <Segment SegmentId="NM1" Repeat="1" />
      <Segment SegmentId="N4" Repeat="1" />
      <Segment SegmentId="MSG" />
    </Loop>
    <Loop LoopId="PID">
      <Name>Product/Item Description</Name>
      <StartingSegment SegmentId="PID" />
      <Segment SegmentId="BLI" Repeat="1" />
      <Segment SegmentId="SPA" Repeat="1" />
      <Segment SegmentId="UD" Repeat="1" />
      <Segment SegmentId="AMT" />
      <Segment SegmentId="AM1" />
      <Segment SegmentId="PDL" />
      <Segment SegmentId="QTY" />
      <Segment SegmentId="DTP" />
      <Segment SegmentId="MSG" />
      <Loop LoopId="INV">
        <Name>Investment Vehicle Selection</Name>
        <StartingSegment SegmentId="INV" />
        <Segment SegmentId="AM1" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="QTY" />
        <Segment SegmentId="LIN" Repeat="2" />
        <Segment SegmentId="RPA" />
      </Loop>
      <Loop LoopId="BEN">
        <Name>Beneficiary or Owner Information</Name>
        <StartingSegment SegmentId="BEN" />
        <Segment SegmentId="NM1" Repeat="1" />
        <Segment SegmentId="N2" Repeat="3" />
        <Segment SegmentId="N3" Repeat="3" />
        <Segment SegmentId="N4" Repeat="1" />
        <Segment SegmentId="REF" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="III" />
        <Segment SegmentId="QTY" />
        <Segment SegmentId="LUI" Repeat="1" />
        <Segment SegmentId="MSG" />
      </Loop>
    </Loop>
    <Loop LoopId="ENT">
      <Name>Entity</Name>
      <StartingSegment SegmentId="ENT" />
      <Segment SegmentId="REF" />
      <Segment SegmentId="LIN" Repeat="9" />
      <Segment SegmentId="DMG" Repeat="1" />
      <Segment SegmentId="DMA" Repeat="1" />
      <Segment SegmentId="LUI" Repeat="1" />
      <Segment SegmentId="DTP" />
      <Segment SegmentId="AM1" />
      <Segment SegmentId="YNQ" />
      <Segment SegmentId="QTY" />
      <Segment SegmentId="MSG" />
      <Loop LoopId="NM1">
        <Name>Individual or Organizational Name</Name>
        <StartingSegment SegmentId="NM1" />
        <Segment SegmentId="N2" Repeat="3" />
        <Segment SegmentId="REF" />
        <Loop LoopId="N3">
          <Name>Address Information</Name>
          <StartingSegment SegmentId="N3" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="COM" Repeat="9" />
          <Segment SegmentId="DTP" />
        </Loop>
      </Loop>
      <Loop LoopId="LQ">
        <Name>Industry Code</Name>
        <StartingSegment SegmentId="LQ" />
        <Segment SegmentId="SPA" Repeat="1" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="MSG" />
        <Loop LoopId="NM1">
          <Name>Individual or Organizational Name</Name>
          <StartingSegment SegmentId="NM1" />
          <Segment SegmentId="N3" Repeat="3" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="REF" />
          <Segment SegmentId="COM" Repeat="3" />
          <Segment SegmentId="LUI" Repeat="1" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="MSG" />
        </Loop>
      </Loop>
      <Loop LoopId="BEN">
        <Name>Beneficiary or Owner Information</Name>
        <StartingSegment SegmentId="BEN" />
        <Segment SegmentId="NM1" Repeat="1" />
        <Segment SegmentId="N2" Repeat="3" />
        <Segment SegmentId="N3" Repeat="3" />
        <Segment SegmentId="N4" Repeat="1" />
        <Segment SegmentId="REF" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="III" />
        <Segment SegmentId="QTY" />
        <Segment SegmentId="LUI" Repeat="1" />
        <Segment SegmentId="MSG" />
      </Loop>
      <Loop LoopId="PID">
        <Name>Product/Item Description</Name>
        <StartingSegment SegmentId="PID" />
        <Segment SegmentId="BLI" Repeat="9" />
        <Segment SegmentId="SPA" Repeat="1" />
        <Segment SegmentId="AMT" />
        <Segment SegmentId="QTY" />
        <Segment SegmentId="DTP" />
        <Segment SegmentId="MSG" />
        <Loop LoopId="PDL">
          <Name>Payment Details</Name>
          <StartingSegment SegmentId="PDL" />
          <Segment SegmentId="REF" />
        </Loop>
        <Loop LoopId="INV">
          <Name>Investment Vehicle Selection</Name>
          <StartingSegment SegmentId="INV" />
          <Segment SegmentId="AM1" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="RPA" />
        </Loop>
        <Loop LoopId="BEN">
          <Name>Beneficiary or Owner Information</Name>
          <StartingSegment SegmentId="BEN" />
          <Segment SegmentId="NM1" Repeat="1" />
          <Segment SegmentId="N2" Repeat="3" />
          <Segment SegmentId="N3" Repeat="3" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="REF" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="III" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="LUI" Repeat="1" />
          <Segment SegmentId="MSG" />
        </Loop>
      </Loop>
      <Loop LoopId="UC">
        <Name>Underwriting Category</Name>
        <StartingSegment SegmentId="UC" />
        <HierarchicalLoop LoopId="HL">
          <Name>Hierarchical Level</Name>
          <Segment SegmentId="UQS" Repeat="1" />
          <Segment SegmentId="YNQ" />
          <Segment SegmentId="NM1" Repeat="1" />
          <Segment SegmentId="N3" Repeat="3" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="COM" Repeat="9" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="MSG" />
          <Segment SegmentId="AM1" />
          <Segment SegmentId="AMT" />
          <Segment SegmentId="III" />
          <Segment SegmentId="EC" Repeat="1" />
          <Segment SegmentId="EMS" Repeat="1" />
          <Segment SegmentId="EMP" Repeat="1" />
          <Segment SegmentId="PCT" />
          <Segment SegmentId="SOI" />
          <Segment SegmentId="LIN" Repeat="2" />
          <Segment SegmentId="REF" />
          <Segment SegmentId="ASL" />
          <Segment SegmentId="TOA" />
          <Segment SegmentId="TOV" />
          <Segment SegmentId="VEH" />
          <Segment SegmentId="CDS" />
          <Segment SegmentId="CED" />
          <Segment SegmentId="SIN" />
          <Segment SegmentId="UCS" />
          <Segment SegmentId="FH" />
          <Segment SegmentId="SPA" Repeat="1" />
          <Segment SegmentId="MPI" Repeat="1" />
        </HierarchicalLoop>
      </Loop>
    </Loop>
    <Loop LoopId="PWK">
      <Name>Paperwork</Name>
      <StartingSegment SegmentId="PWK" />
      <Segment SegmentId="NM1" Repeat="1" />
      <Segment SegmentId="N4" Repeat="1" />
      <Segment SegmentId="REF" />
      <Segment SegmentId="DTP" />
      <Segment SegmentId="SPA" Repeat="1" />
      <Loop LoopId="EFI">
        <Name>Electronic Format Identification</Name>
        <StartingSegment SegmentId="EFI" />
        <Segment SegmentId="BIN" Usage="Required" Repeat="1" />
      </Loop>
    </Loop>
    <Loop LoopId="LX">
      <Name>Assigned Number</Name>
      <StartingSegment SegmentId="LX" />
      <Loop LoopId="PDL">
        <Name>Payment Details</Name>
        <StartingSegment SegmentId="PDL" />
        <Segment SegmentId="REF" />
        <Loop LoopId="AMT">
          <Name>Monetary Amount</Name>
          <StartingSegment SegmentId="AMT" />
          <Segment SegmentId="N1" Repeat="1" />
          <Segment SegmentId="N3" Repeat="2" />
          <Segment SegmentId="N4" Repeat="1" />
          <Segment SegmentId="LIN" Repeat="2" />
          <Segment SegmentId="DTP" />
          <Segment SegmentId="QTY" />
          <Segment SegmentId="MSG" />
        </Loop>
      </Loop>
    </Loop>
    <Loop LoopId="K2">
      <Name>Administrative Message</Name>
      <StartingSegment SegmentId="K2" />
      <Segment SegmentId="DTP" Repeat="1" />
      <Segment SegmentId="NM1" Repeat="1" />
    </Loop>
  </Loop>
</TransactionSpecification>